Education and health care consistently rank among the top concerns for North Carolinians and Americans in public opinion surveys. Expressed desires include better results, higher pay for teachers, lower prices in health care, more choice in schools or doctors, and more convenience. In health care the comparisons are with Europe; in education, with Asia.
The standard line is that we can accomplish our objectives with a more active role for government. Europeans, after all, spend half as much on health care with no worse health. From Japan to Korea, Southeast Asia a decade ago to China and India today, the ever-incipient threat from Asian engineers and scientists has been attributed to better educational systems for more than 40 years.
Strangely, nobody has worried about the lack of government involvement in religion, in the media, in fast-food restaurants, or fad diets limiting choice or quality. In fact, the concern in at least some of these is that more government needs to curb the range of choices.
America is the most religious and religiously tolerant country in the world. Homegrown radical Islam is less of a threat here than in European countries. Every form of Christianity is more vibrant as is the range of practice. Yet government separation from church is firmest here with no government-sanctioned church. Churches compete for members.
No other country has as many local news outlets. Again, there are national networks of television or radio outlets and numerous national cable and satellite channels, but the Public Broadcasting System is just a small percentage of the programming spectrum and came years after the radio and television media developed. While PBS makes great documentaries, it does less well on breaking news. That is the realm of private news organizations, and increasingly the alternative print and online sources.
Despite the best efforts of Congress and Archer Daniels Midland, America also has one of the least distorted markets for agricultural food products and low prices for food — though not sugar. Many researchers attribute the rise in obesity to the lower cost of eating out.
Why, then, do otherwise smart people think government planning can do a better job providing health care than the free-market forces behind $4 prescriptions? Yes, the current health care system with its reliance on insurance company gatekeepers takes too many decisions away from patients and doctors, but a fully centralized system would put even more distance between patients and payments. Even proponents of single-payer systems acknowledge that somebody will have to ration care based on something besides what the patient is willing to pay for.
Any expansion of government in health care would make the best doctors more like the best public school teachers — underpaid and underappreciated. Bad teachers in good school districts get the same ABC bonus as the best teachers, while great teachers in poorly performing districts get nothing.
Principals know who the good teachers are. Superintendents know which are the good schools. Wealthy parents can and do move their children to private schools. Others choose to home school. Some parts of the state have magnet and charter schools.
Expanding the number of charter schools has proven difficult despite the fact that nearly one-third of ninth-graders do not finish high school, that existing schools have long lists of children waiting to enter, and that frustrated applicants are ready and able to start new schools when the opportunity arises.
We should guarantee freedom of education and freedom of health care to all residents. There is no reason to limit the ability of hospitals to build new facilities if there is demand to support them. There is no reason to limit the number or type of schools available to parents and students in some vain hope that every child will suddenly decide to finish high school and go to college. Removing government has worked to ensure freedom of speech and of religion. There is no reason to believe it would not be as fruitful in health care or education.
Coletti is fiscal and health care policy analyst for the John Locke Foundation.